Clinicians require feedback in order to continuously improve and progress as professionals. Peer-to-peer (P2P) assessments provide an evaluation of performance to facilitate coaching and foster continuous improvement by providing developmental feedback. The validity of conclusions drawn from these efforts and the extent to which competencies improve and safety outcomes are realized as a result of coaching and feedback is contingent upon rigorous, psychometrically-driven measurement practices. Currently, methods of P2P assessment in healthcare have yet to focus specifically on critical care, fail to incorporate evaluations of teamwork and patient-centered performance, and demonstrate inadequate reliability and validity evidence. This project addresses these gaps by developing a structured, objective, and evidence-based method for P2P assessments: Peer- and Competency-based Ongoing Approach for Critical Healthcare Evaluations of Skills (P- COACHES). Specifically, the proposed work centers on continuous improvement for intensive care unit (ICU) attending physicians (intensivists) through P2P assessment. This work is important because the attending plays a pivotal role in care delivery, medical education of junior physicians, and establishing behavioral norms for teamwork and patient-centered care. We will leverage our multidisciplinary team of research scientists and ICU intensivists to develop a P2P assessment system for ICU intensivists. Our comprehensive development and validation plan incorporates a formal needs analysis, development of best practices for P2P assessments, and a robust empirical plan that adheres to scientifically robust standards for measurement tool development. Successful completion of the proposed work will result in a scalable approach for conducting P2P assessments that can be applied to evaluate teamwork and patient-centered performance within critical care settings for ICU intensivists, a framework from which future P2P tools in other clinical areas can be developed, and resources for applying this tool for peer coaching to reinforce and sustain important teamwork and patient-centered competencies.